In this issue:
Emerging initiatives funded by the Agency for Healthcare Research and Quality (AHRQ)’s Effective Health Care Program are exploring how electronic health records (EHRs) and their connections to other databases can be used by scientists to conduct comparative effectiveness research.
The projects will establish and enhance computerized clinical data systems to address limitations encountered in observational studies and in randomized controlled trials. For example, while well-designed trials may yield valid conclusions, their findings are based on studies of highly selected groups of patients. Therefore, their conclusions can rarely be generalized to real-world clinical practice.
"An EHR-based infrastructure can yield detailed clinical data and can be designed to meet the needs of researchers as well as add value to clinicians," said Gurvaneet Randhawa, M.D., project director and medical officer at AHRQ’s Center for Outcomes and Evidence.
Eleven projects are using electronic clinical data for comparative effectiveness research on AHRQ priority populations and conditions. They belong to three programs:
The projects are funded for 3 years by the American Reinvestment and Recovery Act. Dr. Randhawa said they show how electronic approaches can be useful to researchers and improve patient outcomes. One project (SUPREME-DM), for example, is building a national registry of diabetes patients while identifying strategies to improve medication adherence. Another (WICER PROSPECT) is utilizing a community-based survey in a low-income, minority neighborhood in New York City to link clinical data from different clinical settings with self-reported information on hypertension.
Lessons from the 11 projects will be shared via the Electronic Data Methods (EDM) Forum. To get involved, including accessing papers and presentations and receiving announcements of upcoming events and news, visit the EDM Forum Web site: www.edm-forum.org.
In the past year, more than 13,000 health care professionals have earned continuing medical education/continuing education (CME/CE) credits via free online activities offered by the Effective Health Care (EHC) Program. The activities help clinicians access and apply the EHC Program’s growing inventory of patient-centered outcomes research findings.
EHC Program CME/CE activities are offered for physicians and physician assistants, nurses and nurse practitioners, pharmacists, dieticians, case managers, health educators, and medical assistants. Participating clinicians come from a variety of practice settings, including primary care, hospitals, health plans, family medicine, and specialty medicine.
The CME/CE activities are presented in six different formats, such as case-based videos, which show examples of clinicians interacting with patients; Web conferences, which are often recorded and archived; and access to Journal of Managed Care Pharmacist (JMCP) articles. Most of the activities are available on mobile phones, tablets, and Droid smartphones.
To highlight the continuing activities for their members, several organizations have posted links to the EHC Program’s continuing education Web site, including the American Nurses Association, National Association of Directors of Nursing Administration in Long Term Care, American Osteopathic Association, Society of Hospital Medicine, Case Management Society of America, American Academy of Physician Assistants, and the American Pharmacists Association.
To learn more and access the CME/CE modules, visit the EHC Program’s continuing education Web site.
Despite their increased use, there is little evidence to assess the safety or compare the effectiveness of first- and second-generation antipsychotics among children and young adults, according to a recent report from AHRQ.
In recent decades, antipsychotic medications have been prescribed increasingly for the one in five children and youth being treated for emotional and behavioral issues. Meanwhile, there is a widespread perception that second-generation antipsychotics (SGAs) are more tolerable and potentially more effective than first-generation antipsychotics (FGAs).
But AHRQ’s comparative effectiveness review, First- and Second- Generation Antipsychotics for Children and Young Adults, suggests clinicians should continue to use caution in prescribing and monitoring antipsychotic medication in youth.
"We only have moderate strength evidence for a few efficacy outcomes, low evidence about safety, and virtually no systematic evaluation of tolerability or acceptability of these medications to patients and families," said Khrista Boylan, M.D., an investigator with the AHRQ-supported University of Alberta Evidence-based Practice Center, which developed the report.
In addition to these conclusions, the review found moderately strong evidence that second-generation antipsychotics, compared with placebo, have significant benefits for treating tics, psychotic symptoms in schizophrenia, manic symptoms in patients with bipolar disorder, and behavior symptoms in children with disruptive behavior disorders and autistic spectrum disorders. The review did not find an effect of antipsychotics on depressive or anxiety symptoms.
Given the need for additional research comparing different classes of antipsychotics, this research review is accompanied by a Future Research Needs paper outlining gaps in evidence and key questions for future research. The full review and other evidence-based resources are on the AHRQ’s Effective Health Care Program Web site: www.effectivehealthcare.ahrq.gov.
Only two osteoporosis treatments—bisphosphonate medications (including alendronate, risedronate, ibandronate, and zoledronic acid) and denosumab—are supported by a high level of evidence for reducing the risk of spinal, hip, and other fractures, according to an updated report from AHRQ.
Strong evidence also supports the use of the medications raloxifene and teriparatide for reducing the risk of spinal fractures.
Overall, however, not enough studies have directly compared the therapies with each other, so the report could not conclusively determine whether one type of osteoporosis therapy is more effective than others at preventing fractures. Most osteoporosis treatments have notable side effects that should be considered when making treatment decisions.
Those findings and others are highlighted in Comparative Effectiveness of Treatment to Prevent Fractures in Men and Women with Low Bone Density-Update, a report from AHRQ’s Effective Health Care Program.
Carolyn Crandall, M.D., M.S., professor of medicine at the University of California, Los Angeles, and lead investigator, said postmenopausal women, especially those who have already experienced fractures, were the most likely to lower their fracture risks by taking osteoporosis medications.
This report updates a 2007 AHRQ review on the topic and includes new information on the effectiveness and risks of recently approved medications, including two new bisphosponates and denosumab, as well as established osteoporosis treatments, including menopausal estrogen therapy, parathyroid hormone, raloxifene, vitamin D, calcium, and physical activity.
Findings from the report will be highlighted soon in upcoming research summaries for clinicians and consumers as well as an electronic decision aid to help patients think about what is important to them when talking with their clinician about treatment options. These and other materials that explore the effectiveness and safety of treatment options for various conditions are on AHRQ’s Effective Health Care Program Web site: www.effectivehealthcare.ahrq.gov.
A new AHRQ Web page, Health Information for Businesses and Their Employees, offers evidence-based health information and resources for businesses and their employees to improve the quality and value of care:
The information is drawn primarily from the AHRQ Effective Health Care Program’s library of unbiased, plain-language consumer research summaries. For more information or to provide comments about the page, please email EHCforBusiness@ahrq.hhs.gov.
To access all Effective Health Care Program resources, visit www.effectivehealthcare.ahrq.gov.
EHC Inside Track is a newsletter highlighting important news and developments from AHRQ’s Effective Health Care Program.
Call 1-800-358-9295 and use reference code C-01 to get free print copies of EHC Program clinician and consumer research summaries.